HIV-Induced Immune Exhaustion in Neonates: A Review of Mechanisms and Implications

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HIV-Induced Immune Exhaustion in Neonates: A Review of Mechanisms and

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Elite Journal of Immunology. Volume 2 issue 3(2024), Pp. 45-61
https://epjournals.com/journals/EJI
HIV-Induced Immune Exhaustion in Neonates: A Review of Mechanisms and Implications
*
Emmanuel Ifeanyi Obeagu1 and Getrude Uzoma Obeagu2
1
Department of Medical Laboratory Science, Kampala International University, Uganda
2
School of Nursing Science, Kampala International University, Uganda
*
Corresponding authour: Emmanuel Ifeanyi Obeagu, Department of Medical Laboratory Science,
Kampala International University, Uganda, emmanuelobeagu@yahoo.com, ORCID: 0000-0002-
4538-0161
Abstract
HIV infection during early life poses unique challenges to neonatal immune development,
potentially leading to immune exhaustion and increased susceptibility to infections. This review
explores the mechanisms and implications of HIV-induced immune exhaustion in neonates,
focusing on the intricate interplay between viral pathogenesis, host immune responses, and
developmental factors. We examine the impact of HIV infection on neonatal immune cell
populations, including T cells, B cells, and myeloid cells, and discuss how viral persistence,
immune dysregulation, and environmental factors contribute to immune exhaustion. Additionally,
we explore the consequences of immune exhaustion in neonates, including impaired pathogen
recognition, reduced vaccine responses, and increased risk of opportunistic infections.
Understanding the mechanisms underlying HIV-induced immune exhaustion in neonates is
essential for optimizing pediatric HIV care and developing targeted interventions to enhance
immune function and improve outcomes in this vulnerable population.
Keywords: HIV, neonates, immune exhaustion, immune development, pediatric HIV infection
Introduction
The neonatal period is a critical stage of immune system development characterized by rapid
maturation and functional adaptation to the extrauterine environment. However, neonates are
particularly vulnerable to infectious diseases, including HIV, due to the immaturity of their
immune defenses. HIV infection during early life poses unique challenges to neonatal immune
Citation: Obeagu EI, Obeagu GU. HIV-Induced Immune Exhaustion in Neonates: A Review of
Mechanisms and Implications. Elite Journal of Immunology, 2024; 2(3): 45-61
1
development, potentially leading to immune exhaustion—a state of functional impairment

characterized by diminished immune responses and increased susceptibility to infections. HIV
infection disrupts normal immune development and function in neonates through various
mechanisms, including direct viral effects on immune cells and dysregulation of immune signaling
pathways. The virus targets key immune cell populations, including CD4+ T cells, CD8+ T cells,
B cells, and myeloid cells, leading to their depletion, dysfunction, and exhaustion. Additionally,
viral persistence, immune activation, and chronic inflammation further contribute to immune
exhaustion in neonates, impairing host defense mechanisms and increasing susceptibility to
opportunistic infections. The intricate interplay between viral pathogenesis, host immune
responses, and developmental factors shapes the trajectory of immune exhaustion in neonatal HIV
infection. Impaired immune function in neonates with HIV-induced immune exhaustion has
profound implications for disease progression, treatment outcomes, and long-term health.
Neonates may exhibit impaired pathogen recognition, reduced vaccine responses, and inadequate
immune control of opportunistic infections. Furthermore, immune exhaustion may compromise
the efficacy of antiretroviral therapy (ART) and other interventions aimed at controlling viral
replication and improving immune function. Addressing the consequences of immune exhaustion
in neonatal HIV infection is crucial for optimizing pediatric HIV care and developing targeted
therapeutic strategies to enhance immune function and mitigate disease progression.1-36
Mechanisms of HIV-Induced Immune Exhaustion in Neonates
HIV infection during the neonatal period disrupts normal immune development and function,
leading to a state of immune exhaustion characterized by impaired immune responses and
increased susceptibility to infections. Several mechanisms contribute to HIV-induced immune
exhaustion in neonates, including direct viral effects on immune cells, dysregulation of immune
signaling pathways, and modulation of the neonatal immune microenvironment. HIV targets key
immune cell populations, including CD4+ T cells, CD8+ T cells, B cells, and myeloid cells,
leading to their depletion, dysfunction, and exhaustion. HIV primarily infects CD4+ T cells, the
central orchestrators of the adaptive immune response, causing a progressive decline in CD4+ T
cell counts and impairing their effector functions. CD8+ T cells, which play a critical role in viral
control and clearance, also undergo functional exhaustion, characterized by decreased cytotoxicity
and cytokine production. Furthermore, HIV infection affects B cell function, impairing antibody
production and humoral immunity, and dysregulates myeloid cell activation and cytokine
secretion, contributing to chronic inflammation and immune dysfunction.37-64
HIV disrupts immune signaling pathways involved in immune activation, regulation, and
tolerance, leading to aberrant immune responses and persistent inflammation. The virus induces
chronic immune activation, characterized by elevated levels of proinflammatory cytokines and
chemokines, which drive immune cell activation and exhaustion. Additionally, HIV alters immune
checkpoint pathways, such as PD-1/PD-L1 and CTLA-4, which regulate T cell function and
maintain immune homeostasis. Dysregulation of immune checkpoint signaling contributes to T
cell exhaustion, characterized by upregulation of inhibitory receptors and functional impairment.
The neonatal immune microenvironment plays a crucial role in shaping immune responses and
2
determining susceptibility to infections. HIV infection alters the neonatal immune

microenvironment through various mechanisms, including dysregulation of cytokine and
chemokine networks, modulation of innate immune responses, and impairment of mucosal
immune defenses. HIV-induced immune dysregulation disrupts the balance between
proinflammatory and anti-inflammatory signals, promoting chronic inflammation and immune
exhaustion. Furthermore, the neonatal gut mucosa, a key site of immune development and
microbial colonization, is particularly vulnerable to HIV-induced damage, leading to gut barrier
dysfunction and microbial translocation.65-85
Implications of Immune Exhaustion in Neonatal HIV Infection
Immune exhaustion in neonatal HIV infection has profound implications for disease progression,
treatment outcomes, and long-term health. Neonates with HIV-induced immune exhaustion may
exhibit impaired pathogen recognition, reduced vaccine responses, and inadequate immune control
of opportunistic infections. Additionally, immune exhaustion may compromise the efficacy of
antiretroviral therapy (ART) and other interventions aimed at controlling viral replication and
improving immune function. Immune exhaustion in neonatal HIV infection may impair the ability
of the immune system to recognize and respond to infectious pathogens, increasing susceptibility
to opportunistic infections. Diminished immune responses, including reduced cytokine production
and impaired antigen presentation, compromise the host's ability to mount effective immune
responses against pathogens, leading to prolonged or recurrent infections. Neonates with HIV-
induced immune exhaustion may exhibit impaired vaccine responses, including reduced antibody
production and diminished T cell activation. Vaccination strategies aimed at boosting immune
responses may be less effective in neonates with compromised immune function, leading to
suboptimal vaccine efficacy and reduced protection against vaccine-preventable diseases.
Furthermore, immune exhaustion may limit the durability of vaccine-induced immunity,
necessitating booster doses or alternative vaccine formulations to maintain protective immunity.86-
115
Immune exhaustion in neonatal HIV infection compromises the immune system's ability to control
opportunistic infections, leading to increased morbidity and mortality. Opportunistic infections,
such as bacterial pneumonia, fungal infections, and viral coinfections, may occur with greater
frequency and severity in neonates with compromised immune function, necessitating aggressive
antimicrobial therapy and supportive care. Immune exhaustion may compromise the efficacy of
antiretroviral therapy (ART) in neonatal HIV infection, leading to persistent viral replication and
disease progression. ART aims to suppress viral load, restore immune function, and prevent
disease progression; however, immune exhaustion may limit the ability of ART to fully control
viral replication and restore immune homeostasis. Additionally, immune exhaustion may increase
the risk of virologic failure and the development of drug resistance mutations, further complicating
treatment outcomes. Immune exhaustion in neonatal HIV infection may have long-term health
implications, including increased risk of chronic immune dysfunction, immune-mediated diseases,
and neurodevelopmental disorders. Persistent immune activation and inflammation associated
with immune exhaustion may contribute to the development of cardiovascular disease, metabolic
3
disorders, and neurocognitive impairment later in life. Furthermore, compromised immune

function may impact growth and development, exacerbating nutritional deficiencies and growth
stunting in affected infants.115-145
Future Directions and Clinical Implications
Advancing our understanding of HIV-induced immune exhaustion in neonates is essential for

guiding clinical practice and improving outcomes in pediatric HIV care. Future research efforts
should focus on identifying biomarkers of immune exhaustion, elucidating the mechanisms
underlying immune dysregulation, and developing novel therapeutic interventions to restore
immune function in neonates with HIV infection. Additionally, strategies to optimize ART
initiation, enhance immune reconstitution, and prevent opportunistic infections are needed to
improve long-term outcomes in this vulnerable population. Identifying biomarkers of immune
exhaustion in neonates with HIV infection is essential for early detection, prognostication, and
monitoring of disease progression. Biomarkers such as immune cell subsets, cytokine profiles, and
immune checkpoint expression may provide valuable insights into the extent of immune
dysfunction and the efficacy of therapeutic interventions. High-throughput omics technologies,
including genomics, transcriptomics, and proteomics, offer promising approaches for identifying
biomarkers associated with immune exhaustion and predicting treatment outcomes.146-151
Elucidating the mechanisms underlying immune dysregulation in neonatal HIV infection is crucial
for developing targeted therapeutic interventions to restore immune function. Understanding how
HIV modulates immune signaling pathways, disrupts immune cell development and function, and
alters the neonatal immune microenvironment may reveal novel therapeutic targets for
intervention.152 Preclinical models of neonatal HIV infection, including animal models and ex vivo
tissue models, offer valuable tools for investigating immune dysregulation and testing potential
therapeutic strategies. Developing novel therapeutic interventions to restore immune function in
neonates with HIV infection represents a critical area of research. Strategies aimed at enhancing
immune reconstitution, reducing immune activation, and reversing immune exhaustion hold
promise for improving treatment outcomes and reducing the burden of opportunistic infections.
Targeted immunomodulatory agents, such as immune checkpoint inhibitors, cytokine therapies,
and cell-based therapies, may offer new avenues for restoring immune function and enhancing
host defense mechanisms in neonates with HIV infection.
Optimizing ART initiation, dosing, and duration is essential for maximizing viral suppression,
preserving immune function, and preventing disease progression in neonates with HIV
infection.153 Early initiation of ART in neonates diagnosed with HIV infection is critical for
achieving rapid viral suppression and minimizing immune damage. Tailoring ART regimens to
the individual needs of neonates, including consideration of drug pharmacokinetics, drug
interactions, and potential adverse effects, is essential for optimizing treatment outcomes and
minimizing treatment-related toxicity. Preventing opportunistic infections in neonates with HIV
infection requires a multifaceted approach that includes antimicrobial prophylaxis, vaccination,
and supportive care. Antimicrobial prophylaxis with agents such as trimethoprim-
4
sulfamethoxazole and azithromycin help prevent bacterial and opportunistic infections in HIV-
exposed neonates. Vaccination strategies aimed at boosting immune responses and enhancing
vaccine efficacy in neonates with HIV infection are essential for reducing the risk of vaccine-
preventable diseases. Additionally, supportive care measures, such as nutritional support, growth
monitoring, and psychosocial support, are essential for promoting overall health and well-being in
neonates with HIV infection.154-156
Conclusion
HIV-induced immune exhaustion in neonates represents a complex and multifaceted challenge

with far-reaching implications for disease progression, treatment outcomes, and long-term health.
Understanding the mechanisms underlying immune exhaustion and its clinical implications is
essential for optimizing pediatric HIV care and improving outcomes in this vulnerable population.
The mechanisms of immune exhaustion in neonatal HIV infection involve a complex interplay of
direct viral effects on immune cells, dysregulation of immune signaling pathways, and modulation
of the neonatal immune microenvironment. These processes contribute to impaired immune
responses, reduced vaccine efficacy, and increased susceptibility to opportunistic infections.
Additionally, immune exhaustion may compromise the efficacy of antiretroviral therapy and have
long-term implications for immune function and overall health.
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9
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50. Obeagu EI, Scott GY, Amekpor F, Obeagu GU. Implications of CD4/CD8 ratios in Human
Immunodeficiency Virus infections. Int. J. Curr. Res. Med. Sci. 2023;9(2):6-13.DOI:
10.22192/ijcrms.2023.09.02.002 links/645a4a462edb8e5f094ad37c/Implications-of-CD4-
CD8-ratios-in-Human-Immunodeficiency-Virus-infections.pdf.
51. Obeagu EI, Ochei KC, Okeke EI, Anode AC. Assessment of the level of haemoglobin and
erythropoietin in persons living with HIV in Umuahia. Int. J. Curr. Res. Med. Sci.
2016;2(4):29-33. links/5711c47508aeebe07c02496b/Assessment-of-the-level-of-
haemoglobin-and-erythropoietin-in-persons-living-with-HIV-in-Umuahia.pdf.
52. Ifeanyi OE, Obeagu GU. The Values of CD4 Count, among HIV Positive Patients in FMC
Owerri. Int. J. Curr. Microbiol. App. Sci. 2015;4(4):906-910.
https://www.academia.edu/download/38320134/Obeagu_Emmanuel_Ifeanyi_and_Obeag
u__Getrude_Uzoma.EMMA2.pdf.
53. Obeagu EI, Okeke EI, Anonde Andrew C. Evaluation of haemoglobin and iron profile
study among persons living with HIV in Umuahia, Abia state, Nigeria. Int. J. Curr. Res.
Biol. Med. 2016;1(2):1-5.
54. Ibebuike JE, Nwokike GI, Nwosu DC, Obeagu EI. A Retrospective Study on Human
Immune Deficiency Virus among Pregnant Women Attending Antenatal Clinic in Imo
State University Teaching Hospital. International Journal of Medical Science and Dental
Research, 2018; 1 (2):08-14.
https://www.ijmsdr.org/published%20paper/li1i2/A%20Retrospective%20Study%20on%
20Human%20Immune%20Deficiency%20Virus%20among%20Pregnant%20Women%2
0Attending%20Antenatal%20Clinic%20in%20Imo%20State%20University%20Teaching
%20Hospital.pdf.
55. Obeagu EI, Obarezi TN, Omeh YN, Okoro NK, Eze OB. Assessment of some
haematological and biochemical parametrs in HIV patients before receiving treatment in
Aba, Abia State, Nigeria. Res J Pharma Biol Chem Sci. 2014; 5:825-830.
56. Obeagu EI, Obarezi TN, Ogbuabor BN, Anaebo QB, Eze GC. Pattern of total white blood
cell and differential count values in HIV positive patients receiving treatment in Federal
Teaching Hospital Abakaliki, Ebonyi State, Nigeria. International Journal of Life Science,
Biotechnology and Pharama Research. 2014; 391:186-189.
57. Obeagu EI. A Review of Challenges and Coping Strategies Faced by HIV/AIDS
Discordant Couples. Madonna University journal of Medicine and Health Sciences. 2023;
3 (1): 7-12.
58. Oloro OH, Obeagu EI. A Systematic Review on Some Coagulation Profile in HIV
Infection. International Journal of Innovative and Applied Research. 2022;10(5):1-11.
10
59. Nwosu DC, Obeagu EI, Nkwuocha BC, Nwanna CA, Nwanjo HU, Amadike JN, Ezemma
MC, Okpomeshine EA, Ozims SJ, Agu GC. Alterations in superoxide dismutiase, vitamins
C and E in HIV infected children in Umuahia, Abia state. International Journal of
Advanced Research in Biological Sciences. 2015;2(11):268-271.
60. Ifeanyi OE, Uzoma OG, Stella EI, Chinedum OK, Abum SC. Vitamin D and insulin
resistance in HIV sero positive individuals in Umudike. Int. J. Curr. Res. Med. Sci.
2018;4(2):104-108.
61. Ifeanyi OE, Leticia OI, Nwosu D, Chinedum OK. A Review on blood borne viral
infections: universal precautions. Int. J. Adv. Res. Biol. Sci. 2018;5(6):60-66.
62. Nwovu AI, Ifeanyi OE, Uzoma OG, Nwebonyi NS. Occurrence of Some Blood Borne
Viral Infection and Adherence to Universal Precautions among Laboratory Staff in Federal
Teaching Hospital Abakaliki Ebonyi State. Arch Blood Transfus Disord. 2018;1(2).
63. Chinedu K, Takim AE, Obeagu EI, Chinazor UD, Eloghosa O, Ojong OE, Odunze U. HIV
and TB co-infection among patients who used Directly Observed Treatment Short-course
centres in Yenagoa, Nigeria. IOSR J Pharm Biol Sci. 2017;12(4):70-75.
64. Offie DC, Obeagu EI, Akueshi C, Njab JE, Ekanem EE, Dike PN, Oguh DN. Facilitators
and barriers to retention in HIV care among HIV infected MSM attending Community
Health Center Yaba, Lagos Nigeria. Journal of Pharmaceutical Research International.
2021;33(52B):10-19.
65. Obeagu EI, Obeagu GU, Ede MO, Odo EO, Buhari HA. Translation of HIV/AIDS
knowledge into behavior change among secondary school adolescents in Uganda: A
review. Medicine (Baltimore). 2023;102(49): e36599. doi:
10.1097/MD.0000000000036599. PMID: 38065920; PMCID: PMC10713174.
66. Anyiam AF, Arinze-Anyiam OC, Irondi EA, Obeagu EI. Distribution of ABO and rhesus
blood grouping with HIV infection among blood donors in Ekiti State Nigeria. Medicine
(Baltimore). 2023;102(47): e36342. doi: 10.1097/MD.0000000000036342. PMID:
38013335; PMCID: PMC10681551.
67. Echefu SN, Udosen JE, Akwiwu EC, Akpotuzor JO, Obeagu EI. Effect of Dolutegravir
regimen against other regimens on some hematological parameters, CD4 count and viral
load of people living with HIV infection in South Eastern Nigeria. Medicine (Baltimore).
2023;102(47): e35910. doi: 10.1097/MD.0000000000035910. PMID: 38013350; PMCID:
PMC10681510.
68. Opeyemi AA, Obeagu EI. Regulations of malaria in children with human
immunodeficiency virus infection: A review. Medicine (Baltimore). 2023;102(46):
e36166. doi: 10.1097/MD.0000000000036166. PMID: 37986340; PMCID:
PMC10659731.
69. Obeagu EI, Obeagu GU, Obiezu J, Ezeonwumelu C, Ogunnaya FU, Ngwoke AO, Emeka-
Obi OR,
70. Obeagu EI, Ubosi NI, Uzoma G. Storms and Struggles: Managing HIV Amid Natural
Disasters. Int. J. Curr. Res. Chem. Pharm. Sci. 2023;10(11):14-25.
71. Obeagu EI, Obeagu GU. Human Immunodeficiency Virus and tuberculosis infection: A
review of prevalence of associated factors. Int. J. Adv. Multidiscip. Res. 2023;10(10):56-
62.
11
72. Obeagu EI, Obeagu GU. Unmasking the Truth: Addressing Stigma in the Fight Against
HIV. Elite Journal of Public Health. 2024;2(1):8-22.
73. Obeagu EI, Obeagu GU, Okwuanaso CB. Optimizing Immune Health in HIV Patients
through Nutrition: A Review. Elite Journal of Immunology. 2024;2(1):14-33.
74. Obeagu EI, Obeagu GU. Utilization of immunological ratios in HIV: Implications for
monitoring and therapeutic strategies. Medicine. 2024;103(9): e37354.
75. Obeagu EI, Obeagu GU. CD8 Dynamics in HIV Infection: A Synoptic Review. Elite
Journal of Immunology. 2024;2(1):1-3.
76. Obeagu EI, Obeagu GU. Implications of B Lymphocyte Dysfunction in HIV/AIDS. Elite
77. Obeagu EI, Obeagu GU. Maternal Influence on Infant Immunological Responses to HIV:
A Review. Elite Journal of Laboratory Medicine. 2024;2(1):46-58.
78. Obeagu EI, Obeagu GU. Understanding B Lymphocyte Functions in HIV Infection:
Implications for Immune Dysfunction and Therapeutic Strategies. Elite Journal of
Medicine. 2024;2(1):35-46.
79. Obeagu EI, Obeagu GU. Platelet-Driven Modulation of HIV: Unraveling Interactions and
Implications. Journal home page: http://www. journalijiar. com.;12(01).
80. Obeagu EI, Anyiam AF, Obeagu GU. Managing Hematological Complications in HIV:
Erythropoietin Considerations. Elite Journal of HIV. 2024;2(1):65-78.
81. Obeagu EI, Obeagu GU, Hauwa BA, Umar AI. Hematocrit Variations in HIV Patients Co-
infected with Malaria: A Comprehensive Review. Journal home page: http://www.
journalijiar. com.;12(01).
82. Obeagu EI, Obeagu GU. Synergistic Effects of Blood Transfusion and HIV in Children
Under 5 Years with Severe Malaria: A Review. Elite Journal of HIV. 2024;2(1):31-50.
83. Obeagu EI, Anyiam AF, Obeagu GU. Unveiling B Cell Mediated Immunity in HIV
Infection: Insights, Challenges, and Potential Therapeutic Avenues. Elite Journal of HIV.
2024;2(1):1-5.
84. Obeagu EI, Obeagu GU. Hematocrit Fluctuations in HIV Patients Co-infected with Malaria
Parasites: A Comprehensive Review. Int. J. Curr. Res. Med. Sci. 2024;10(1):25-36.
85. Obeagu EI, Obeagu GU. Transfusion Therapy in HIV: Risk Mitigation and Benefits for
Improved Patient Outcomes. Sciences. 2024;4(1):32-37.
86. Obeagu EI, Obeagu GU. Mental Health and Psychosocial Effects of natural disaster on
HIV Patients. Sciences. 2024;4(1):38-44.
87. Obeagu EI, Obeagu GU. Eosinophil-Associated Changes in Neonatal Thymic T
Regulatory Cell Populations in HIV-Infected Pregnancies. Elite Journal of Health Science.
2024;2(1):33-42.
88. Obeagu EI, Obeagu GU. Advances in Understanding the Impact of Blood Transfusion on
Anemia Resolution in HIV-Positive Children with Severe Malaria: A Comprehensive
Review. Elite Journal of Haematology. 2024;2(1):26-41.
89. Obeagu EI, Ayogu EE, Obeagu GU. Interactions between Blood Transfusion and
Antiretroviral Medications: Implications for Patient Care. Elite Journal of Medicine.
2024;2(2):104-15.
12
90. Obeagu EI, Obeagu GU. Maternal Eosinophilic Responses in HIV-Positive Pregnant
Women: Unraveling Immunological Dynamics for Improved Maternal-Fetal Health. Elite
91. Obeagu EI, Anyanwu CN, Obeagu GU. Challenges and Considerations in Managing Blood
Transfusion for Individuals with HIV. Elite Journal of HIV. 2024;2(2):1-7.
92. Obeagu EI, Ubosi NI, Obeagu GU, Akram M. Early Infant Diagnosis: Key to Breaking the
Chain of HIV Transmission. Elite Journal of Public Health. 2024;2(1):52-61.
93. Obeagu EI, Obeagu GU. Understanding Hematocrit Fluctuations in HIV-Malaria
Coinfection for Improved Management. Elite Journal of Public Health. 2024;2(1):22-34.
94. Obeagu EI, Obeagu GU. The Impact of Erythropoietin on Preeclampsia in HIV-Positive
Women: A Review. Elite Journal of Nursing and Health Science. 2024;2(1):21-31.
95. Obeagu EI, Obeagu GU. Platelet Distribution Width (PDW) as a Prognostic Marker for
Anemia Severity in HIV Patients: A Comprehensive Review. Journal home page:
http://www. journalijiar. com.;12(01).
96. Obeagu EI, Obeagu GU. Neonatal Outcomes in Children Born to Mothers with Severe
Malaria, HIV, and Transfusion History: A Review. Elite Journal of Nursing and Health
Science. 2024;2(3):38-58.
97. Obeagu EI, Obeagu GU. Assessing Platelet Functionality in HIV Patients Receiving
Antiretroviral Therapy: Implications for Risk Assessment. Elite Journal of HIV.
2024;2(3):14-26.
98. Obeagu EI, Obeagu GU. Advancements in HIV Prevention: Africa's Trailblazing
Initiatives and Breakthroughs. Elite Journal of Public Health. 2024;2(1):52-63.
99. Obeagu EI, Obeagu GU. Maternal Influence on Infant Immunological Responses to HIV:
A Review. Elite Journal of Laboratory Medicine. 2024;2(1):46-58.
100. Obeagu EI, Obeagu GU. Counting Cells, Shaping Fates: CD4/CD8 Ratios in HIV.
Elite Journal of Scientific Research and Review. 2024;2(1):37-50.
101. Obeagu EI, Anyiam AF, Obeagu GU. Managing Hematological Complications in
HIV: Erythropoietin Considerations. Elite Journal of HIV. 2024;2(1):65-78.
102. Obeagu EI, Obeagu GU. Immune Modulation in HIV-Positive Neonates: Insights
and Implications for Clinical Management. Elite Journal of Nursing and Health Science.
2024;2(3):59-72.
103. Obeagu EI, Ayogu EE, Obeagu GU. Impact on Viral Load Dynamics:
Understanding the Interplay between Blood Transfusion and Antiretroviral Therapy in HIV
Management. Elite Journal of Nursing and Health Science. 2024;2(2):5-15.
104. Obeagu EI, Obeagu GU. Understanding B Lymphocyte Functions in HIV Infection:
Implications for Immune Dysfunction and Therapeutic Strategies. Elite Journal of
Medicine. 2024;2(1):35-46.
105. Obeagu EI, Anyanwu CN, Obeagu GU. Challenges and Considerations in
Managing Blood Transfusion for Individuals with HIV. Elite Journal of HIV. 2024;2(2):1-
7.
106. Obeagu EI, Obeagu GU. Understanding ART and Platelet Functionality:
Implications for HIV Patients. Elite Journal of HIV. 2024;2(2):60-73.
13
107. Obeagu EI, Obeagu GU. The Role of Blood Transfusion Strategies in HIV
Management: Current Insights and Future Directions. Elite Journal of Medicine.
2024;2(1):10-22.
108. Obeagu EI, AmaezeAA O, Obeagu GU. B Cell Deficiency and Implications in HIV
Pathogenesis: Unraveling the Complex Interplay. Elite Journal of Nursing and Health
Science. 2024;2(2):33-46.
109. Obeagu EI, Obeagu GU. Eosinophil Dynamics in Pregnancy among Women Living
with HIV: A Comprehensive Review. Int. J. Curr. Res. Med. Sci. 2024;10(1):11-24.
110. Obeagu EI, Obeagu GU. Hematocrit Fluctuations in HIV Patients Co-infected with
Malaria Parasites: A Comprehensive Review. Int. J. Curr. Res. Med. Sci. 2024;10(1):25-
36.
111. Obeagu EI, Obeagu GU. Unveiling the Role of Innate Immune Activation in
Pediatric HIV: A Review. Elite Journal of Immunology. 2024;2(3):33-44.
112. Obeagu EI, Obeagu GU. Harnessing B Cell Responses for Personalized
Approaches in HIV Management. Elite Journal of Immunology. 2024;2(2):15-28.
113. Obeagu EI, Obeagu GU, Hauwa BA, Umar AI. Neutrophil Dynamics: Unveiling
Their Role in HIV Progression within Malaria Patients. Journal home page: http://www.
journalijiar. com.;12(01).
114. Obeagu EI, Obeagu GU, Hauwa BA, Umar AI. Hematocrit Variations in HIV
Patients Co-infected with Malaria: A Comprehensive Review. Journal home page:
http://www. journalijiar. com.;12(01).
115. Obeagu EI, Igwe MC, Obeagu GU. The Power of Unity: Collective Efforts in
Confronting HIV Stigma. Elite Journal of Public Health. 2024;2(3):22-36.
116. Obeagu EI, Anyiam AF, Obeagu GU. Managing Anemia in HIV through Blood
Transfusions: Clinical Considerations and Innovations. Elite Journal of HIV. 2024;2(1):16-
30.
117. Obeagu EI, Obeagu GU. Maternal Eosinophilic Responses in HIV-Positive
Pregnant Women: Unraveling Immunological Dynamics for Improved Maternal-Fetal
Health. Elite Journal of Immunology. 2024;2(1):47-64.
118. Obeagu EI, Obeagu GU. Platelet Aberrations in HIV Patients: Assessing Impacts
of ART. Elite Journal of Haematology, 2024; 2 (3).:10-24.
119. Obeagu EI, Obeagu GU. Hematological Changes Following Blood Transfusion in
Young Children with Severe Malaria and HIV: A Critical Review. Elite Journal of
Laboratory Medicine. 2024;2(1):33-45.
120. Obeagu EI, Anyiam AF, Obeagu GU. Erythropoietin Therapy in HIV-Infected
Individuals: A Critical Review. Elite Journal of HIV. 2024;2(1):51-64.
121. Obeagu EI, Ubosi NI, Obeagu GU, Obeagu AA. Nutritional Strategies for
Enhancing Immune Resilience in HIV: A Review. Int. J. Curr. Res. Chem. Pharm. Sci.
2024;11(2):41-51.
122. Obeagu EI, Obeagu GU. The Crucial Role of Erythropoietin in Managing Anemia
in HIV: A Review. Elite Journal of Scientific Research and Review. 2024;2(1):24-36.
123. Obeagu EI, Obeagu GU. Impact of Maternal Eosinophils on Neonatal Immunity in
HIV-Exposed Infants: A Review. Elite Journal of Immunology. 2024;2(3):1-8.
14
124. Obeagu EI, Anyiam AF, Obeagu GU. Unveiling B Cell Mediated Immunity in HIV
Infection: Insights, Challenges, and Potential Therapeutic Avenues. Elite Journal of HIV.
2024;2(1):1-5.
125. Obeagu EI, Obeagu GU. Anemia and Erythropoietin: Key Players in HIV Disease
Progression. Elite Journal of Haematology, 2024; 2 (3).:42-57.
126. Obeagu EI, Obeagu GU. Platelet Dysfunction in HIV Patients: Assessing ART
Risks. Elite Journal of Scientific Research and Review. 2024;2(1):1-6.
127. Obeagu EI, Ubosi NI, Obeagu GU, Akram M. Early Infant Diagnosis: Key to
Breaking the Chain of HIV Transmission. Elite Journal of Public Health. 2024;2(1):52-61.
128. Obeagu EI, Obeagu GU. Transfusion Therapy in HIV: Risk Mitigation and Benefits
for Improved Patient Outcomes. Sciences. 2024;4(1):32-7.
129. Obeagu EI, Obeagu GU. P-Selectin and Immune Activation in HIV: Clinical
Implications. Elite Journal of Health Science. 2024;2(2):16-29.
130. Obeagu EI, Obeagu GU. Mental Health and Psychosocial Effects of natural disaster
on HIV Patients. Sciences. 2024;4(1):38-44.
131. Obeagu EI, Obeagu GU. Optimizing Blood Transfusion Protocols for Breast
Cancer Patients Living with HIV: A Comprehensive Review. Elite Journal of Nursing and
Health Science. 2024;2(2):1-7.
132. Obeagu EI, Obeagu GU. Advances in Understanding the Impact of Blood
Transfusion on Anemia Resolution in HIV-Positive Children with Severe Malaria: A
Comprehensive Review. Elite Journal of Haematology. 2024;2(1):26-41.
133. Obeagu EI, Obeagu GU. Transfusion-Related Complications in Children Under 5
with Coexisting HIV and Severe Malaria: A Review. Int. J. Curr. Res. Chem. Pharm. Sci.
2024;11(2):9-19.
134. Obeagu EI, Obeagu GU. Impact of Blood Transfusion on Viral Load Dynamics in
HIV-Positive Neonates with Severe Malaria: A Review. Elite Journal of Scientific
Research and Review. 2024;2(1):42-60.
135. Obeagu EI, Ayogu EE, Obeagu GU. Interactions between Blood Transfusion and
Antiretroviral Medications: Implications for Patient Care. Elite Journal of Medicine.
2024;2(2):104-5.
136. Obeagu EI, Obeagu GU. P-Selectin Expression in HIV-Associated Coagulopathy:
Implications for Treatment. Elite Journal of Haematology, 2024; 2 (3).:25-41.
137. Obeagu EI, Obeagu GU. Eosinophil-Associated Changes in Neonatal Thymic T
Regulatory Cell Populations in HIV-Infected Pregnancies. Elite Journal of Health Science.
2024;2(1):33-42.
138. Obeagu EI, Obeagu GU. Exploring the Role of L-selectin in HIV-related Immune
Exhaustion: Insights and Therapeutic Implications. Elite Journal of HIV. 2024;2(2):43-59.
139. Obeagu EI. Erythropoietin and the Immune System: Relevance in HIV
Management. Elite Journal of Health Science. 2024;2(3):23-35.
140. Obeagu EI, Obeagu GU. The Impact of Erythropoietin on Preeclampsia in HIV-
Positive Women: A Review. Elite Journal of Nursing and Health Science. 2024;2(1):21-
31.
15
141. Obeagu EI, Obeagu GU. Unraveling the Role of Eosinophil Extracellular Traps
(EETs) in HIV-Infected Pregnant Women: A Review. Elite Journal of Nursing and Health
Science. 2024;2(3):84-99.
142. Obeagu EI, Obeagu GU. Hematologic Considerations in Breast Cancer Patients
with HIV: Insights into Blood Transfusion Strategies. Elite Journal of Health Science.
2024;2(2):20-35.
143. Obeagu EI, Obeagu GU. L-selectin and HIV-Induced Immune Cell Trafficking:
Implications for Pathogenesis and Therapeutic Strategies. Elite Journal of Laboratory
Medicine. 2024;2(2):30-46.
144. Obeagu EI, Obeagu GU. The Intricate Relationship Between Erythropoietin and
HIV-Induced Anemia: Unraveling Pathways for Therapeutic Insights. Int. J. Curr. Res.
Chem. Pharm. Sci. 2024;11(2):30-40.
145. Obeagu EI, Obeagu GU. The Role of L-selectin in Tuberculosis and HIV
Coinfection: Implications for Disease Diagnosis and Management. Elite Journal of Public
Health. 2024;2(1):35-51.
146. Kalu OA, Ukibe NR, Onyenekwe CC, Okoyeagu RC, Nnaemeka WS, Onyenekwe
AJ, Ukibe EG, Ukibe BC, Ukibe VE, Obeagu EI. Assessment of Serum Cystatin C,
Microalbumin Levels and Egfr in HIV Seropositive Individuals based on Age and Gender
in NAUTH, Nnewi, Nigeria. Elite Journal of Medicine. 2024;2(3):48-59.
147. Obeagu EI, Obeagu GU. Understanding Immune Cell Trafficking in Tuberculosis-
HIV Coinfection: The Role of L-selectin Pathways. Elite Journal of Immunology.
2024;2(2):43-59.
148. Obeagu EI, Obeagu GU. Eosinophilic Changes in Placental Tissues of HIV-
Positive Pregnant Women: A Review. Elite Journal of Laboratory Medicine. 2024;2(1):14-
32.
149. Obeagu EI, Obeagu GU. P-Selectin and Platelet Activation in HIV: Implications
for Antiviral Therapy. Elite Journal of Scientific Research and Review. 2024;2(1):17-41.
150. Obeagu EI, Obeagu GU. Strength in Unity: Building Support Networks for HIV
Patients in Uganda. Elite Journal of Medicine. 2024;2(1):1-6.
151. Obeagu EI, GU EE. Understanding the Intersection of Highly Active Antiretroviral
Therapy and Platelets in HIV Patients: A Review. Elite Journal of Haematology, 2024; 2
(3).:111-7.
152. Lu J, Wu W. Cholinergic modulation of the immune system–A novel therapeutic
target for myocardial inflammation. International Immunopharmacology. 2021;
93:107391.
153. Ford D, Turner R, Turkova A, Penazzato M, Musiime V, Bwakura-Dangarembizi
M, Violari A, Chabala C, Puthanakit T, Sudjaritruk T, Cressey TR. Optimizing clinical
trial design to maximize evidence generation in pediatric HIV. JAIDS Journal of Acquired
Immune Deficiency Syndromes. 2018;78: S40-48.
154. Obeagu EI, Obeagu GU. Anemia in HIV: The Role of Erythropoietin in Disease
Progression. Elite Journal of Haematology, 2024; 2(4): 51-67
16
155. Obeagu EI, Obeagu GU. ART and Platelet Dynamics: Assessing Implications for
HIV Patient Care. Elite Journal of Haematology, 2024; 2(4): 68-85
156. Obeagu EI, Obeagu GU. Impact of Breastfeeding on Infant Immune Responses in
the Context of HIV. Elite Journal of Nursing and Health Science, 2024; 2(4):23-39
17
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HIV-Induced Immune Exhaustion in Neonates: A Review of Mechanisms and

Article · April 2024

Emmanuel Ifeanyi Obeagu Getrude Uzoma Obeagu

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HIV-Induced Immune Exhaustion in Neonates: A Review of Mechanisms and Implications

development, potentially leading to immune exhaustion—a state of functional impairment

Mechanisms of HIV-Induced Immune Exhaustion in Neonates

determining susceptibility to infections. HIV infection alters the neonatal immune

Implications of Immune Exhaustion in Neonatal HIV Infection

disorders, and neurocognitive impairment later in life. Furthermore, compromised immune

Future Directions and Clinical Implications

Advancing our understanding of HIV-induced immune exhaustion in neonates is essential for

HIV-induced immune exhaustion in neonates represents a complex and multifaceted challenge

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